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Resources for general practitioners

GPs participating in the ANSC program are provided with a suite of resources developed in conjunction with the Sydney Local Health District (SLHD) maternity facilities in an effort to provide consistent care for GP shared care patients.
Additional pregnancy-related infomation can be viewed on HealthpathwaysSydney 

ANSC GP Resource Manual

 

The ANSC GP Resource Manual is intended as a guide for general practitioners participating in the SLHD Antenatal Shared Care Program. The manual's content is linked with HealthPathways where relevant.

  pdf ANSC GP Resource Manual v 8.0. (October 2018) (5.19 MB)  
On opening PDF file, Click Bookmark Icon  important, Add, bookmark, Favorite, Favourite, Note, Ribbon Icon on top bar (right side) to view contents page and navigate through the manual 

ANSC GP protocol: schedule of visits

GPs participating in the ANSC program will be expected to adhere to the agreed guidelines as outlined in the SLHD ANSC Protocol when caring for their antenatal shared care patients.

PDF document pdf SLHD Antenatal Shared Care Protocol - Antenatal Clinic  (704 KB)  ( September 2018) 
PDF document pdf SLHD Antenatal Shared Care Protocol - Birth Centre  (122 KB)  ( September 2018) 

Breaches of the ANSC Protocol that affect patient outcomes will be recorded for quality assurance purposes. Any investigations requested by the GP for a woman under his/her care must be followed up by the GP concerned. At all times it is the primary responsibility of the provider ordering the test or noting an abnormal finding to ensure appropriate follow-up management and communication, irrespective of whether a copy has been sent to the participating hospital. 

Early Pregnancy Assessment Service (EPAS) - RPAH

 

The aim of EPAS is to identify and manage ectopic pregnancies, vaginal bleeding in pregnancy, or miscarriage less than 20 weeks gestation. The service is available to assist you with the management of your haemodynamically stable patient.

If patient is clinical unstable and less than 20 weeks pregancy, arrange immediate transfer to relevant hospital Emergency Department  

Urgent review for pregnant patients < 20 weeks gestation, contact relevant hospital on-call Gynaecology Registrar
Contact relevant hospital on-call O&G Registrar for all pregnant patients > 20 weeks gestation.These women should be sent to hospital Delivery Ward 

Referral criteria

Patient must:

  • be less than 20 weeks pregnant,and
  • have abdominal pain or vaginal bleeding,and
  • be experiencing only mild to moderate symptoms,

                 or

  • have an incomplete miscarriage or threatened miscarriage, confirmed by ultrasound

Women attending Canterbury Hospital who fulfill referral criteria (and willing to travel) may be referred to EPAS at RPAH or St George Hospital 

Exclusion criteria

  • Patient more than 20 weeks pregnant – ph. Obstetric Registrar (02) 9515‑6111 for management  in the Delivery Ward.
  • Termination of pregnancy
  • Dating scans
  • Management of hyperemesis

Referral advice 

For advice or guidance regarding patient referral, please contact Clinical Midwifery Consultant (CMC) Mon - Sun  08.00am-4.00pm  Ph: 0429 728 608  Fax 9515 3454 (Health Professionals ONLY). There is no need to contact CMC for all EPAS referrals, only if further referral advice is required.

 For all other non early pregnancy/gynaecological issues, please contact hospital O&G Registrar ph. 9515 6111.

Required information

  • Pathology copy of blood group result
  • Most recent serum quantitative BHCG where available
  • Any previous ultrasound results
  • Significant medical history
  • RPAH Fetal Medicine ultrasound referral form
  • Complete EPAS Referral Form and give to patient to take to clinic  

Inform the patient 

  • Must present to the Women’s Ambulatory Care Reception (Level 5) at 7.30 am (Mon- Fri) the next business day. 
    There are no appointment times and waiting times will vary.
  • Preparation requirements – a full bladder is not required and fasting from midnight is preferable.
  • If the patient consents, a report will be mailed to the general practitioner on the day of consultation.
    PDF document Patient Brochure -  pdf RPA  (283 KB) pdf Early bleeding in pregnancy (283 KB)
Hyperglycaemia in pregnancy (including gestational diabetes)

PDF document  pdf Diagnostic Testing for Hyperglycaemia in pregnancy (504 KB)  - resource which includes defining risk, screening protocol, interpreting results, postnatal follow-up and pre-pregnancy assessment
PDF document  pdf Glucose Tolerance Test (GTT) Instructions (149 KB)  - patient instruction for GTT testing
external link ADIPS - Australian Diabetes In Pregnancy Society- Resources for both health professionals and patients

Perinatal mental health

Early identification of women experiencing psychosocial problems and mental health conditions in the perinatal period it important so they can recieve timely support and care. 

external link  pdf Mental Health Care in the Perinatal Period - Australian Clinical Practice Guideline (681 KB)  - Centre of Perinatal Excellence (COPE)
external link COPE Centre for Perinatal excellence - provides resources for both health professionals and consumers
external link Screening and assessment tools : Psychosocial risk assessment (ANRQ/PNRQ) & Assessment of depression and anxiety (EPDS. Includes D&A and D&FV questions 
PDF document  pdf Looking after your perinatal mental health (611 KB)  - Information for patients
external link beyondblue - provides access to a variety of information regarding perinatal mental health

Clinical Services
Psychological Support Services (PSS)

PSS provides FREE short term face-to-face psychological services to people living in the CESPHN region. Priority groups include women experiencing perinatal depression from conception to 12 months after birth.

For more information visit our PSS page

St John of God Medical Centre 
Free Medicare fund Psychiatrist service for women in the perinatal period that cannot afford a consult with a private psychiatrist.
The clinic provides short term assessment, therapy, and treatment plan and the woman is referred back to the GP for ongoing management

For more information and referral processes visit pdf Clinic Information (476 KB) and pdf GP Referral Form  (261 KB)

Prenatal screening

All women, regardless of age should be counselled and offered the option for screening for chromosomal anomalies.

Antenatal Shared Care GPs can refer women directly to the Fetal Medicine Unit (Phone: 9515 6042 or Fax: 9515 6579) for the following tests:

  • Combined First Trimester Screening (cFTS)
  • Non-Invasive Prenatal Screening (NIPT)
  • Chorionic Villus Sampling (CVS)
  • Aminocentesis

Relevant referral forms are required to be completed for referral for these tests.

Timing of procedures 
Procedure Gestation (wks) 
Non- Invasive Prenatal Testing (NIPT)  10 weeks onwards
Combined First Trimester Screening (cFTS)  11+1-13+6 
Chorionic Villus Sampling (CVS)  11-13
Amniocentesis 15-19

The Fetal Medicine Unit (FMU) at RPA Women and Babies routinely offers Combined First Trimester Screening (cFTS): ultrasound scan (nuchal translucency and nasal bone) plus biochemistry to pregnant women booking for delivery at RPA Women and Babies and Canterbury Hospitals 

Referral for cFTS: 

Access to Non-Invasive Prenatal Testing (NIPT) will be as a second line screening tool for women at high or intermediate level of risk after cFTS. The NIPT test is not available through Medicare and women will have to fund this test themselves. For further information contact the RPA Genetic Counsellors ph 9515 5080 or Fetal Medicine Unit ph 9515 6042

 Resources

 PDF document Patient Brochure- Screening tests for your baby in early pregnancy- NSW Health:  Centre for Genetics Education 
 PDF document Patient Brochure- Prenatal testing booklet - NSW Health : Centre for Genetics Education
external link First Trimester Sceening Learning Module: NSW Centre For Genetics: On-line education module 
external linkSearch for Certified Operators to perform Nuchal Translucency - RANZCOG Nuchal Translucency: Ultrasound, education and monitoring program

Translated material regarding genetics, prenatal testing and pregnancy are located at the Multicultural Health Communication Service - NSW Health.

Thyroid disease

PDF document pdf Thyroid Disease Guidelines and referral flowchart (390 KB) : Who to screen, Thyroid Function Test Reference ranges in pregnancy, Referral criteria